Popliteal Retrograde Approach is Effective and Safe for Superficial Femoral Artery Chronic Total Occlusion

Abstract

Objective: Endovascular treatment (EVT) using a popliteal approach is effective for superficial femoral artery (SFA) chronic total occlusion (CTO); however, its effectiveness, safety, and consequent complications are unclear. Materials and Methods:We studied 324 consecutive EVTs (in 187 patients) performed at three centers between April 2008 and March 2013, and selected all EVTs that included SFA CTO regions. A total of 91 EVTs (in 65 patients) were included and divided into two groups; "with popliteal approach" (WPA) and "without popliteal approach" (WOPA). Results: Despite higher rates of hypertension (WPA, 88.9% vs. WOPA, 69.1%; p = 0.04) and CTO length >200 mm (55.6% vs. 28.3%, respectively; p <0.01), the primary success rate was better in the WPA group (97.2% vs. 78.2%, respectively; p <0.01); however, both total complication rate and major complication rate were not significantly different. We compared popliteal puncture using a sheath and using a microcatheter alone. There were no significant differences between sheath and microcatheter use in terms of primary success rates (95.5% vs. 100%, respectively; p = 0.61) and puncture site complications (22.7% vs. 14.2%, respectively; p = 0.53). Conclusion: A popliteal approach improved the primary success rate of EVT for SFA CTO.Keywords: endovascular treatment, superficial femoral artery total occlusion, retrograde approach, popliteal puncture long, diffuse occlusions and/or long total occlusions, and it commonly requires endovascular treatment (EVT). 1) The primary success rate of EVT for SFA CTO has improved from 75% in 2001 2) to 81%-94% in 2014. 3) EVTs for SFA are generally managed by the antegrade approach, which uses a contralateral retrograde puncture or ipsilateral antegrade puncture of the common femoral artery. Alternatively, the popliteal approach is less frequently utilized. The popliteal approach, first reported by Tonnesen et al. 4) and initially performed with patients in a prone position, 5) has been associated with complications such as dissections, arterial ruptures, arteriovenous fistula, pseudoaneurysms, bleeding, and hematomas, 6,7) making it less popular than the antegrade approach. 8) Furthermore, to avoid changing a patient's position, popliteal puncture with patients lying in the supine position has been reported. 9) In addition, the use of lower-diameter puncture instruments, such as 3 Fr sheaths or microcatheters, instead of the conventional 4-6 Fr sheaths, has been attempted. 10,11) With the use of these modifying techniques, the aim is to reduce complications and the nuisance of popliteal puncture, and it has since gained popularity.This study investigates the effectiveness and safety of the popliteal retrograde approach for SFA CTO. We compared EVT with the popliteal approach and EVT without popliteal approach in terms of primary success rates and puncture site complications. Another purpose of this study was to clarify the type of complications occurring during EVT with and without the popliteal approach. Furthermore, we analyzed...

Twelve months follow-up after retrograde recanalization of superficial femoral artery chronic total occlusion

“…In the group of patients with distal SFA/popliteal occlusion or with a narrow lumen of tibial vessels the retrograde approach can be difficult. The most common complications are associated with bleeding events, perforations of the vessels or damage to the vascular-nervous bunch [7]. …”

Retrograde Use of Frontrunner Catheter in Superficial Femoral Artery for Flushing Long Segment Occlusions Involving Distal Common Femoral Artery

“…A pedal access rather than the distal SFA or popliteal artery seemed to be a better option for this elderly patient, as it provided convenience with the supine procedure. 9 ) Moreover, the atherosclerotic stenosis was extended to the distal part of the SFA in this patient. The small profile of the Frontrunner catheter (0.76–1 mm of diameter, 2.8 French distal tip) makes it optimal for pedal access introduction.…”

Novel paclitaxel-coated balloon angioplasty via single retrograde popliteal access for challenging superficial femoral artery and iliac artery lesions?

“…Although, there have been some reports on use of the retrograde technique almost routinely as a facilitating adjunct to antegrade femoral access [13][14][15][16], its use as a sole rather than an alternative or adjunctive to antegrade technique is rare. In one study where primary success of intervention was compared between patients receiving antegrade (n = 55 patients) vs. retrograde (n = 36 patients) approach, the decision for performing retrograde access was made in advance in all but three patients in the retrograde group [17]. In this study, after initial retrograde access was performed in the prone position, the patient was placed in the supine position and the procedure was continued.…”